Public Release: 19-Jun-2013
Children from the poorest families are twice as likely to contract malaria than the least poor

The collaborative study, led by Durham University and the London School of Hygiene &Tropical Medicine, is published today in The Lancet and unusually brings together the health and development communities.
Half the world's population is at risk from malaria. A review of studies from different locations across the world with risk factors for the disease showed clearly that in these impoverished communities, the risk of malaria was doubled in the poorest children compared with the least poor.

The team considered how aspects of development, such as improved house construction, could complement existing interventions such as insecticide-treated bednets or spraying insecticide on the walls of houses.
Funding from the project came from the UK government's Department for International Development (DIFD). The team of researchers looked at the relationship between malaria and socio-economic status (SES) in children aged 15 and under.

A widely cited example suggests that a 10 per cent reduction in malaria is associated with 0.3 per cent growth in Gross Domestic Product in sub-Saharan Africa.**

Steve Lindsay, Professor in the School of Biological and Biomedical Sciences, at Durham University said:
"There has long been an association between poverty and malaria, but here we clearly demonstrate that in impoverished communities it is the poorest who suffer most, irrespective of where they live in the world. The fact that the chances of contracting the disease are so much higher among the poorest of the poor compared with the least poor is really quite startling.

"Wealth is positively associated with other factors known to be beneficial in combating the disease, including better educated parents, greater quality of housing, better access to treated bednets and antimalarials and improved nutritional status of children. Malaria and poverty therefore constitute a vicious cycle for the poorest households, exacerbating variation in health and wealth."

Although there has been a significant reduction in the instances of the disease globally over the last ten years, malaria remains one of the most significant global public health problems. According to the World Health Organisation, there were about 219 million cases of malaria in 2010 and an estimated 660,000 deaths. Africa is the most affected continent: about 90 per cent of all malaria deaths occur there.

Professor Lindsay said:
"Long-lasting insecticidal nets and indoor residual spraying are both highly efficient ways of reducing transmission quickly and, combined with anti-malarial drugs, are undoubtedly a major reason for the decline in malaria seen in sub-Saharan Africa. However, such pressure on mosquito and parasite populations has already led to the spread of resistant strains of mosquitos and malaria parasites.

"In addition, we are experiencing 'donor fatigue', due to the financial crisis in the West, which could create a grave risk of a resurgence of malaria. It is vitally important that we continue to control malaria with insecticide-treated bednets and indoor residual spraying, which can only be done with financial support from the West."

Lucy Tusting an Epidemiologist at the London School of Hygiene and Tropical Medicine, said:

"Malaria and poverty have been closely associated throughout history and it was mainly development that caused the disease to disappear from Europe and North America in previous centuries. As Africa develops, the story is likely to be similar. However it is vital to maintain high use of insecticide-treated bednets, indoor residual spraying and effective antimalarial drugs.

"Many aspects of development can protect against malaria, such as better housing or land drainage. In Khartoum, Sudan, malaria control has focused on improving drainage in the city, repairing leaking water pipes and changing irrigation techniques to reduce standing water, at relatively low cost. Malaria control programs elsewhere could adopt similar policies."

Professor Richard Smith, Health Economist at the London School of Hygiene & Tropical Medicine, said:

"The analysis represents a comparison of the very poorest children with the least poor children within highly impoverished communities. The difference in the odds of malaria in the poorest children are likely to have been even greater if the studies were expanded to include children from wealthier homes."

The research also involved collaborators at the Institute of Development Studies in Brighton, and the National Malaria Control Program, Khartoum, Sudan.

The research team advocates that development programmes should be an essential component of malaria control. Increased wealth and improved standards of living directly stemming from socio-economic development could prove fundamental in ensuring that malaria transmission continues to decline in much of Asia, South America and Africa, as witnessed historically in Europe and North America.

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Notes to Editors

ADDITIONAL INFORMATION

* Socio-economic status (SES) was indicated by 1) not owning defined household assets, 2) having relatively low household income, 3) a low score in an asset-based index of SES, constructed by principal components or factor analysis or 4) parents having an unskilled rather than an skilled occupation.

A copy of the paper "Can socio-economic development be an effective 'intervention' against malaria? A systematic review and meta-analysis" is available on request.

The first author of the paper is Lucy Tusting, a graduate of Durham University.

The research team searched Medline, Web of Science, Embase, the Cochrane Database of Systematic Reviews, the Campbell Library, the Center for Reviews and Dissemination, Health Systems Evidence, and the Evidence for Policy and Practice Information (EPPI) and Co-ordinating Centre Evidence Library to identify studies published between 1 January 1980 and 12 July 2011.

The meta-analysis was restricted to comparisons between the highest (least poor) and lowest (poorest) groups.

About Professor Steve Lindsay

Steve Lindsay, Professor in the School of Biological and Biomedical Sciences at Durham University, was a member of the team which first demonstrated that insecticide treated bednets (ITNs) reduced deaths from malaria in African children.

Over the past thirty years, Professor Lindsay and his team have carried out studies in Africa to look at how malaria and other vector borne diseases are controlled. Studies conducted by the team have led to the development of novel tools for vector control, and this work has influenced international policy on the control of malaria and other important diseases, and saved thousands of lives. Professor Lindsay is Chair of the Larval Source Management workstream for the Roll Back Malaria Partnership, a global framework for co-ordinated action against malaria which informs international policy.

He also provides support to the World Health Organisation as well as the Bill and Melinda Gates Foundation, advising on vector control research.

MEDIA INFORMATION

Professor Steve Lindsay can be contacted on +44(0) 191 334 1291 or s.w.lindsay@durham.ac.uk. He is available for interview on Monday 17 June 13.00-17.00 and Tuesday 18 June 11.00 - 17.00.

A broadcast quality ISDN line is available. Bookings can be arranged via the Media Relations Office on the contact details above. The ISDN number is +44 (0)191 386 2749.

Images

A high resolution headshot of Professor Steve Lindsay is available on request from the Media Relations Office.

Source information

"Can socio-economic development be an effective 'intervention' against malaria? A systematic review and meta-analysis" published in The Lancet on 19 June 2013.

A copy of this paper is available from Durham University Media Relations Office on +44 (0)191 334 6075 or email media.relations@durham.ac.uk

About Durham University: Durham University is a world top-100 university with a global reputation and performance in research and education. The most recent UK league tables place Durham in the top echelon of British universities academically. Durham is ranked in the top 5 UK universities in the influential Sunday Times University Guide 2013; is 26th in the world for the impact of its research (THE citations ratings) and 20th in the world for the employability of its students by blue-chip companies worldwide. We are a residential Collegiate University: England's third oldest university and at our heart is a medieval UNESCO World Heritage Site, of which we are joint custodians with Durham Cathedral. Durham is a member of the Russell Group of leading research-intensive UK universities. http://www.durham.ac.uk

About the London School of Hygiene & Tropical Medicine

The London School of Hygiene & Tropical Medicine is a world-leading centre for research and postgraduate education in public and global health, with 3,500 students and more than 1,000 staff working in over 100 countries. The School is one of the highest-rated research institutions in the UK, and was recently cited as one of the world's top universities for collaborative research. The School's mission is to improve health and health equity in the UK and worldwide; working in partnership to achieve excellence in public and global health research, education and translation of knowledge into policy and practice. http://www.lshtm.ac.uk

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